Electronic patient file is a work in progress, users not sufficiently involved (2024)

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This article was originally published in German and has been automatically translated.

Why digitalization in the healthcare sector is only making slow progress despite all efforts was also a key topic at the Big Bang Health Festival alongside AI. In other areas, digitalization works without sanctions. There are many reasons for this, one of the main reasons cited by the participants in the panel talk "Digitalization in healthcare: Not just showing what works, but: doing it!" that users are usually not involved in the development processes at an early stage, as this costs time and even more money.

Applications miss the reality of life

According to cancer blogger Susanne Zsoter, digital applications are "made for patients, but unfortunately not with us patients" and "ignore our reality and our care needs". This also applies to the electronic patient file (elektronische Patientenakte, ePA), to which PDF documents and images can currently be uploaded. According to the Federal Ministry of Health (BMG), however, there are enough reasons to automatically create the ePA for all people with statutory health insurance – unless they object. An advertising campaign will soon be launched to explain the nine reasons for the ePA. At the same time, as with the e-prescription, those involved are criticizing a test phase that is far too short.

According to Dr. Carina-Nina Vorisek from Charité Berlin, there has been a lack of interoperability and a lack of clinical perspective. The BMG hopes to counteract this with various laws – including the Hospital Care Relief Act, the Act to Accelerate Digitization in the Healthcare System and the law that makes Gematik a BMG authority again. There is also a lack of digital skills, for example in the training of doctors. Nevertheless, a lot is happening in the background, for example data is gradually being structured. It will take time for the data to arrive in the ePA in a structured form in the future. According to those involved, there are good applications, but these are mostly isolated solutions in individual practices and hospitals.

According to Gregor Jelen from the consulting firm Hepicc GmbH, there are dozens of examples where the user perspective has been neglected – i.e. doctors, pharmacists, nursing staff and patients. According to Jelen, it is perfectly possible to build products that everyone wants, but they are "probably also undesirable in our system" – because some people want to defend their property.

Instead, the ePA will come automatically for everyone in 2025. And even if everyone were obliged to use it, not everyone would do so. "Most people use WhatsApp, Facebook or shop online like world champions, but when it comes to health digitization, everyone has reservations. We need to overcome these concerns," said Jelen. Data protection does not prevent the use of applications, but is often put forward and used as an excuse.

Talking to each other

For successful digitalization, it is therefore important for everyone involved to be able to talk to each other and participate, which is why the Federal Ministry of Health launched a "participatory process" in 2021. However, there have been repeated reports from various quarters that the process is not as participatory as initially promised.

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However, Health Minister Karl Lauterbach sees the late digitalization as an advantage, as the Pharmazeutische Zeitung (PZ) reports. According to him, countries such as Denmark or Estonia have data, but modern evaluation with AI is not possible. "We have a great advantage here, it's the grace of late birth," the PZ quotes the minister as saying. He is already in close contact with companies such as OpenAI. Lauterbach has also already spoken to Microsoft.

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His aim is to attract pharmaceutical companies to Germany with well-prepared data – thanks to the Medical Research Act and the digital laws. Pharmaceutical companies such as Bayer have already announced their intention to invest more in Germany, while others have already invested.

State medicine on the rise?

Instead of Health Minister Karl Lauterbach, who should have been on the program, Stefan Reker from the Association of Private Health Insurers and Christian Keutel from the Siemens company health insurance fund were harshly critical of Health Minister Karl Lauterbach's expensive "state medicine". AOK boss Carola Reimann had already described him as the "most expensive health minister of all time".

For those with statutory health insurance, the highest increase in contributions to date is on the cards. In addition to demographic change and costly reforms such as hospital reform and digitalization, this is also due to the much-discussed "Healthy Heart Act" (GHG) passed by the cabinet at the end of August. Instead of the promised prevention, insured persons would receive a drug subscription. There is no point in spending money and "throwing statins at all the children", said Reker. The original version of the law was intended to give children and young people faster access to statins as a preventative measure. These drugs are intended to reduce the risk of cardiovascular disease, but are not without their dangers.

Prevention through medication

The draft was already much criticized, not only by the health insurance funds, but also by the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA) and the Institut for Quality and Efficiency in Health Care (PDF). Although the G-BA welcomed the previous changes at the end of August, as "the danger of healthcare moving more in the direction of state medicine" has been significantly reduced by the new draft, it is nevertheless regrettable "that the cabinet decision does not attach the importance to primary prevention that it should. [...] Especially when it comes to preventing cardiovascular diseases, a more health-conscious lifestyle and lifestyle changes can be much more effective often than the lifelong administration of medication."

"Because the law doesn't mention exercise, nutrition or health literacy. Nor does it mention higher taxes on unhealthy foods or a ban on tobacco advertising", writes Ärzteblatt editor-in-chief Michael Schmedt.

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(mack)

Electronic patient file is a work in progress, users not sufficiently involved (2024)
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